Adhesive capsulitis. NPTE Study Guide: Master the NPTE

Adhesive capsulitis/Idiopathic frozen shoulder/periarthritis: Development of dense adhesive fibrosis & scarring in shoulder capsule = restricted AROM & PROM. Caused by chronic inflammation & may be seen in rotator cuff, biceps tendon, & synovial tissue. This differs from RA or OA by arthritic changes in the cartilage and bone. Seen typically in ages 40–65 years; females; associated w/ DM & thyroid disease, self-limiting, resolves on its own; capsular pattern loss. Goal is to increase ROM w/ GH mobilizations; worst case=may need closed manipulation under anesthesia.

1. Primary frozen shoulder: No known cause. May provoke chronic inflammation in musculotendinous or synovial tissue, like the rotator cuff, biceps tendon, or joint capsule.

2. Secondary frozen shoulder: Pervious issues w/ a period of pain &/or restricted motion ie RA, trauma, immobilization

• Stage 1. > 3 months duration. Gradual onset of pain that increases w/ movement & is present at night. Loss of ext rot w/ intact rotator cuff strength is common. 

• Freezing. 3-9 months. Persistent & intense pain even at rest. Limited motion in all directions & cannot be fully restored with an intra-articular injection.

• Frozen. 9-15 months. Pain only w/ movement, significant adhesions, & limited GH motions. Excessive scapulothoracic is a typical compensation. Deltoid, rotator cuff, biceps, & tricep atrophy.

• Thawing. 15-24 months. Minimal pain, no synovitis but significant capsular restrictions from adhesions. Gradual motion improvement. May never regain normal ROM.